外伤后脑性盐耗综合征(附13例报告)

Cerebral Salt Wasting Syndrome(CSWS)after Cerebral Ttrauma

目的 探讨颅脑伤后脑性盐耗综合征的临床特点及治疗方法。方法 每日定时检测血钠及观察尿量变化并根据其变化进行治疗。结果 13例患者中 ,伤后第 4～ 7天血钠平均为 10 7mmol/L ,尿钠平均为 6 2 mmol/L ,血渗透压平均 2 0 5 m Osmol/kg,尿渗压平均 40 9m Osmol/kg,尿比重平均 1.0 2 5 ,其中 5例治疗上予以限水 ,出现低血钠伴有中心静脉压 (CVP)下降 ,意识状况加深 ;补给充足水、盐后 ,伤后第 14～ 2 1天 ,血钠平均回升至 137mmol/L,基本恢复正常。 2周恢复 8例 ,3例 4周内恢复 ,1例半年内恢复 ,1例患者伤后 7天死亡。结论 颅脑伤特别是下丘脑、三脑室旁脑挫裂伤易出现脑性盐耗综合征 (CSWS) ,应区别于抗利尿激素分泌不足综合征 SIADH;脑性盐耗综合征(CSWS)患者应补给充足水、盐 ,根据水、钠检测水平治疗。

Objective To study the cerebral salt wasting syndrome(CSWS)after cerebral trauma.Methods The blood sodium and urine in 13 patients with cerebral trauma were observed.Results In 13 cases presented with hyponatremia(average 107mmol/L),low blood osmotic pressure(average 205 mOsmol/kg),high natriuresis(average 62mmol/L),high urine osmotic pressure(average 409mOsmol/kg)and high urine specific gravity(average 1.025)4～7 days after the cerebral trauma,5 cases were treated with limited-water,the outcome were more severe hyponatrimia,low CVP and unconsciousness.After given enough water and salt,the blood natrium were 137mmol/L 14～21 days after injury.8 cases recovered in two weeks after injury,3 cases in four weeks,one cases in half a year and one died in the eventh days.Conclusions Brain injury is tend to go with CSWS,especially the contusion and laceration of hypothalamus and the region near the 3rd ventricle.The treatment of CSWS must be different with syndrome of inappropriate antidiuretic hormore secretion(SIADH).